Provider Demographics
NPI:1821536954
Name:WEBSTER SURGERY CENTER, LP
Entity Type:Organization
Organization Name:WEBSTER SURGERY CENTER, LP
Other - Org Name:WEBSTER SURGERY CENTER CASTRO VALLEY
Other - Org Type:Other Name
Authorized Official - Title/Position:GENERAL PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GLEN
Authorized Official - Middle Name:K
Authorized Official - Last Name:LAU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:510-451-1875
Mailing Address - Street 1:80 GRAND AVE
Mailing Address - Street 2:SUITE 250
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94612-3725
Mailing Address - Country:US
Mailing Address - Phone:510-451-1875
Mailing Address - Fax:510-839-9588
Practice Address - Street 1:20998 REDWOOD DR
Practice Address - Street 2:
Practice Address - City:CASTRO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94546
Practice Address - Country:US
Practice Address - Phone:510-576-8525
Practice Address - Fax:510-576-0248
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WEBSTER SURGERY CENTER, LP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-02-09
Last Update Date:2017-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical